Prevention of HIV Infection in High-Risk Social Networks of African American MSM

非裔美国男男性接触者高风险社交网络中艾滋病毒感染的预防

• 批准号: 8010368
• 负责人: Jeffrey A Kelly
• 金额: $ 107.31万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-28 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8010368
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Advocate; Affect; African American; Alcohol or Other Drugs use; American; Anus; Behavior Therapy; Binding; Biological; Bisexual; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Cities; Collaborations; Color; Communities; Community Participation; Contracts; Counseling; Country; Data; Development; Diagnosis; Diffuse; Disease; Drug usage; Eastern Europe; Economics; Employee Strikes; Enrollment; Epidemic; Ethnic Origin; Foundations; Frequencies; Friends; Gays; HIV; HIV Infections; HIV/STD; Health; Health Personnel; Human immunodeficiency virus test; Incidence; Individual; Infection; International; Intervention; Intervention Trial; Interview; Laboratories; Language; Life Style; Measures; Methods; Minority; Modality; Modeling; Outcome; Participant; Persons; Phase; Pilot Projects; Play; Population; Preparation; Prevalence; Prevention; Prevention approach; Preventive Intervention; Procedures; Provider; Public Health; Publishing; Race; Randomized; Recommendation; Recording of previous events; Recruitment Activity; Reporting; Research; Risk; Risk Behaviors; Risk Reduction; Risk Reduction Behavior; Sampling; Services; Sex Behavior; Sex Orientation; Shock; Site; Social Network; Specimen; Stigmata; Structure; Testing; Training; Treatment Efficacy; United States; United States Public Health Service; Visit; Vulnerable Populations; Work; arm; base; behavior change; comparative effectiveness; condoms; contextual factors; cost; cost effectiveness; directed attention; ethnic minority population; falls; group counseling; health disparity; high risk; high risk sexual behavior; indexing; informant; man; member; men; men who have sex with men; novel; oral communication; prevent; primary outcome; programs; prospective; public health relevance; public health research; randomized trial; sex; sex risk; social; social stigma; theories; therapy design; uptake

DESCRIPTION (provided by applicant): Risk for HIV infection in the United States falls along sharp lines of disparity related to sexual orientation and race/ethnicity. HIV infection has always taken a heavy toll on men who have sex with men (MSM) and also on African Americans. However, HIV incidence disparity is most striking of all for MSM who are also African American, a segment that probably accounts for less than one percent of the American population but fully 25% of all new HIV infections in the United States. Surprisingly, very few HIV prevention interventions designed for African American MSM have been undertaken, and most existing approaches have relied on individual or small-group risk reduction counseling. These existing models have limited cultural and practical suitability for reaching high-risk African American MSM who are hidden in the community and unlikely to seek out sexual risk reduction counseling. Interventions directed to individuals alone also do not attend sufficiently to the important influence played by social norms and social network factors on risk behavior. In contrast to individual counseling models, HIV prevention interventions that are directed to social networks of Black MSM in the community and that work through natural influence channels within these networks hold the potential for reaching deeply into hidden and vulnerable populations of African American MSM. Network-level HIV prevention interventions rely on oral communication traditions and cultural models appropriate in minority communities, and can strengthen social network normative support for risk reduction. Following a 1-year formative research phase that will provide data needed to contextualize the study's recruitment, assessment, and intervention content and delivery methods, we will undertake a social network-level intervention outcome trial in 3 cities: Milwaukee, Cleveland, and Miami. Project-wide, 24 sociocentric networks of African American MSM-each expected to be composed of approximately 40 people (total n=960 participants)-will be recruited. 12 of the networks (n=480 participants) will be randomized to a comparison condition and receive HIV/STD testing, treatment, and individual counseling. The other 12 networks (n=480) will receive the same counseling and testing and also a social network intervention that identifies, trains, and engages empirically-identified influence leaders of each network to deliver ongoing, theory-based, and culturally tailored HIV prevention advice, recommendations, and support to other network members. The study will determine the comparative effectiveness of the social network intervention to the counseling, testing, and treatment comparison condition on measures of sexual risk, substance use associated with sexual risk behavior, and STD/HIV incidence assessed with laboratory measures at 6- and 18-month followup points. The study aim is to develop and determine the efficacy of an intervention modality capable of reaching and preventing HIV among high-risk African American MSM in the community. PUBLIC HEALTH RELEVANCE: 56,000 Americans continue to contract HIV each year, and African American MSM account for a far disproportionate number of incident infections. Public health efforts to reduce HIV incidence in the United States require the development of new prevention approaches delivered using modalities that can target and reach those population segments at greatest vulnerability. If successful, this research will identify an HIV prevention intervention approach, practical for public health service providers, that lends itself well to rapid uptake and use by CBOs, health departments, and minority organizations concerned about AIDS.

描述（由申请人提供）：在美国，艾滋病毒感染的风险福尔斯沿着与性取向和种族/民族相关的明显差异线下降。艾滋病毒感染一直是男男性行为者（MSM）和非裔美国人的沉重负担。然而，艾滋病毒发病率的差异对于也是非洲裔美国人的男男性行为者来说是最引人注目的，这一部分可能占美国人口的不到1%，但占美国所有新艾滋病毒感染的25%。令人惊讶的是，为非洲裔美国男男性接触者设计的艾滋病毒预防干预措施很少，大多数现有的方法都依赖于个人或小团体的风险降低咨询。这些现有的模式有有限的文化和实际适用性，以达到高风险的非洲裔美国男男性接触者谁是隐藏在社区和不太可能寻求性风险降低咨询。仅针对个人的干预措施也没有充分考虑到社会规范和社会网络因素对风险行为的重要影响。与个体咨询模式相反，针对社区中黑人男男性行为者的社交网络，并通过这些网络中的自然影响渠道开展工作的艾滋病毒预防干预措施，有可能深入到非洲裔美国人男男性行为者的隐藏和脆弱人群中。网络一级的艾滋病毒预防干预措施依赖于适合少数民族社区的口头交流传统和文化模式，可以加强社会网络对减少风险的规范性支持。在为期1年的形成性研究阶段（将提供研究招募、评估和干预内容及实施方法所需的数据）之后，我们将在3个城市进行社交网络水平的干预结局试验：密尔沃基、克利夫兰和迈阿密。在整个项目范围内，将招募24个以社会为中心的非裔美国人MSM网络，每个网络预计由大约40人组成（总共n=960名参与者）。其中12个网络（n=480名参与者）将被随机分配到一个比较条件，并接受艾滋病毒/性病检测，治疗和个人咨询。其他12个网络（n=480）将接受相同的咨询和测试，以及社会网络干预，识别，培训和参与每个网络的影响力领导者，以提供持续的，基于理论的，文化上量身定制的艾滋病毒预防咨询，建议和支持其他网络成员。该研究将确定社会网络干预的咨询，测试和治疗比较条件下的性风险，与性风险行为相关的物质使用，以及在6个月和18个月的随访点用实验室测量评估的STD/HIV发病率的措施的比较有效性。该研究的目的是开发和确定一种干预方式的有效性，这种干预方式能够在社区中的高风险非洲裔美国人MSM中达到和预防艾滋病毒。 公共卫生关系：每年有56，000名美国人继续感染艾滋病毒，非洲裔美国人的男男性接触者占感染事件的比例远远不成比例。在美国，减少艾滋病毒发病率的公共卫生工作需要制定新的预防方法，使用能够针对和接触最脆弱人群的模式。如果成功的话，这项研究将确定一种艾滋病毒预防干预方法，对公共卫生服务提供者来说是可行的，这将有助于社区组织、卫生部门和关注艾滋病的少数民族组织迅速吸收和使用。